10-8: Life on the Line

with Charles Remsberg

When your patrol car needs to be an ambulance

When do you make that decision to immediately transport rather than wait for medical help?

When time is critical and running out, your best bet for saving the life of a wounded fellow officer may be to load him into your squad car and haul ass to the nearest ER rather than wait for the arrival of EMS.

That proved to be the case in Chicago recently when Tac Officer Del Pearson was shot in the upper torso by a 20-year-old gangbanger during a foot pursuit. Pearson was bleeding profusely, with the bullet lodged near his spine, when Sergeant Chris Kapa and Officer Kirsten Lund reached the spot where he lay.

They quickly realized that he needed medical aid stat and sped him to the hospital in the backseat of Kapa’s patrol car. By the time they got him to the ER, he’d reportedly lost three-fourths of the blood in his body — but he survived. If they’d waited for an ambulance, chances are he’d have been DOA.

So when do you make that decision to immediately transport rather than wait for medical help? Dr. Matthew Sztajnkrycer, an active SWAT doc, an instructor for the Force Science Institute, and head of emergency medicine research at the Mayo Clinic, offers some guidelines.

Generally speaking, Sztajnkrycer says, patrol car transport is most appropriate for “a very specific subset of patients”: victims of gunshot wounds or stab wounds that have penetrated the body’s trunk (chest, back, belly, or pelvic area), where physical pressure or a tourniquet cannot be applied to stop the blood flow inside, and who are going into shock from their injury.

“This is very different from blunt trauma or from bleeding that can be controlled by external pressure while waiting for EMS,” he says. “These people are bleeding to death internally and urgently need trauma surgery.”

They will show signs of shock, including a weak or thready pulse and altered mental state ranging from confusion and agitation to lethargy and coma. Their skin will be pale and clammy, and they will look “really bad based on your experience of looking at injured people.”

With shock from penetrating trunk wounds, Sztajnkrycer says, the victim “ideally needs to be in the hands of a surgeon within 20 minutes after being injured. If you are five to ten minutes from a hospital that has the capability for emergency surgery and feel EMS can’t make that timetable, load the victim into your patrol car and go.”

If an ambulance or helicopter is en route, you can always arrange through dispatch to meet them part way, assuming that would save time. In any case, “call ahead and let the hospital know exactly what’s coming in and when, so they can have a trauma team set up and ready to go,” Sztajnkrycer advises. “That can save precious minutes.”

During the transport, “there’s probably not much you can do” to address internal injuries, Sztajnkrycer says. He does, however, recommend removing the stricken officer’s sidearm as a safeguard against a confused or irrational act because of possibly diminished blood flow to the victim’s brain.

Sztajnkrycer cites several research studies that document the success rate of transporting victims of penetrating trunk wounds by squad car. When adjusted for the fact that police-driven individuals tend to be more critically injured than many carried by EMS, the survival rate for the two transport modes is roughly the same, he points out.

Indeed, studies have indicated that patients with penetrating trunk wounds had worse outcomes than expected when transported by ambulance. Looking at the data, the suggestion is that EMS crews delayed time to surgery for these critically injured patients by performing procedures at the scene that were unnecessary for the emergencies at hand. Thus, a “scoop and run” approach for these patients is recommended.

Sztajnkrycer believes that agency command staff and policy-makers should “understand that transport by squad car is a valid option” in dire situations and “support officers’ decisions” in those circumstances.

“Not every decision is going to have as happy an outcome as the recent situation in Chicago,” he told PoliceOne. “But there should be no second-guessing after the fact. These are clearly high-stress, critical incidents and officers will do what they think is the right thing, given the totality of circumstances.”

About the author

Charles Remsberg co-founded the original Street Survival Seminar and the Street Survival Newsline, authored three of the best-selling law enforcement training textbooks, and helped produce numerous award-winning training videos. His nearly three decades of work earned him the prestigious O.W. Wilson Award for outstanding contributions to law enforcement and the American Police Hall of Fame Honor Award for distinguished achievement in public service.

Buy Charles Remsberg's latest book, Blood Lessons, which takes you inside more than 20 unforgettable confrontations where officers' lives are on the line.